Amputation Levels in High-Risk Chronic Limb-Threatening Ischemia Patients

Lower extremity amputations secondary to diabetes and vascular disease result in huge costs to the healthcare system and have significant psychological effects on patients. Limb salvage has become an important specialty within podiatric medicine, aiming to keep patient's ambulatory and prevent readmissions and repeat amputations. The purpose of this chapter is to describe the different levels of amputation in the foot and ankle and discuss relevant adjunctive surgical procedures to reduce the risk of postoperative complications. A thorough understanding of the biomechanics of the foot and ankle is necessary. Additionally, it is important to utilize any available vascular imaging or non-invasive vascular studies as well as wound stratification systems when planning amputation levels. Outcomes vary widely depending on perfusion and systemic comorbidities. A multidisciplinary team approach is best in limb salvage to treat underlying systemic illnesses which can result in failure of the amputation. Several factors including the current functional status of the patient, should be considered before selecting a surgical procedure for limb salvage.